Supplementary Material for: Routine Use of Probiotics in Preterm Infants: Longitudinal Impact on the Microbiome and Metabolome

<b><i>Background:</i></b> Probiotics are live microbial supplements that colonize the gut and potentially exert health benefit to the host. <b><i>Objectives:</i></b> We aimed to determine the impact of a probiotic (Infloran®: <i>Lactobacillus acidophilus</i>-NCIMB701748 and <i>Bifidobacterium bifidum</i>-ATCC15696) on the bacterial and metabolic function of the preterm gut while in the neonatal intensive care unit (NICU) and following discharge. <b><i>Methods:</i></b> Stool samples (n = 88) were collected before, during, and after probiotic intake from 7 patients, along with time-matched controls from 3 patients. Samples were also collected following discharge home from the NICU. Samples underwent bacterial profiling analysis by 16S rRNA gene sequencing and quantitative PCR (qPCR), as well as metabolomic profiling using liquid chromatography mass spectrometry. <b><i>Results:</i></b> Bacterial profiling showed greater <i>Bifidobacterium </i>(15.1%) <i>and Lactobacillus</i> (4.2%) during supplementation compared to the control group (4.0% and 0%, respectively). While <i>Lactobacillus</i> became reduced after the probiotic had been stopped, <i>Bifidobacterium</i> remained high following discharge, suggestive of successful colonisation. qPCR analysis showed a significant increase (p ≤ 0.01) in <i>B. bifidum</i> in infants who received probiotic treatment compared to controls, but no significant increase was observed for <i>L. acidophilus</i> (p = 0.153). Metabolite profiling showed clustering based on receiving probiotic or matched controls, with distinct metabolites associated with probiotic administration. <b><i>Conclusions:</i></b> Probiotic species successfully colonise the preterm gut, reducing the relative abundance of potentially pathogenic bacteria, and effecting gut functioning. <i>Bifidobacterium</i> (but not <i>Lactobacillus</i>) colonised the gut in the long term, suggesting the possibility that therapeutically administered probiotics may continue to exert important functional effects on gut microbial communities in early infancy.